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Application Form

This application is only possible for students having received a personal invitation code allowing to apply for the school without having to pass any audition.
Please note that any scholarship request, in addition to the one already received (if any) will imply the parents to provide all official documents about their patrimony and revenues.

Mosa Education Program

Personal invitation code *

Education Program

Identification information

First Name *

Last Name *

Gender *

Male

Female

Birth Place *

Birth Date *

Nationality *

ID/Passport Country *

Native language *

Preferred communication language *

Size (cm) *

Face Photo *

Full Length Photo *

ID/Passport Student *

Validity student passport

ID/Passport of a Parent/Tutor *

Validity parent passport

Email *

Phone *

Street and Number *

Postal Code *

City *

Country *

Full Name of Father

Email of Father

Phone of Father

Full Name of Mother

Email of Mother

Phone of Mother

Full Name of Guardian

Email of Guardian

Phone of Guardian

Academic Studies

Current Academic School *

Current Academic Level/Degree *

Do you wish to follow academic studies independently of the Athénée Charles Rogier - Liège 1 (only possible for 16+, under conditions)? *

Yes

To be filled for Students NOT following academic studies at Athénée Charles Rogier - Liège 1

Which academic program will you follow?

To be filled for Students following academic studies at Athénée Charles Rogier - Liège 1

Birth certificate is only mandatory for those studying out of Belgium. Their school reports and birth certificate must all be translated by a sworn translator if the originals are not in one of the following languages: French, Dutch, German, English, Italian, Spanish (Castilian) or Portuguese.

End-of-year school reports from the previous two years

Current year last school report

Birth certificate

Dance experience

Number of year(s) of Classical Dance Courses *

Number of year(s) of Contemporary Dance Courses *

Attended Dance Schools *

Tuition Fee

Applicable Tuition Fee (must be consistent with the student's nationality)

Hosting

Hosting Preferences *

Request for a Hosting Family during Week-ends and Holidays (EUR 15 per night - about EUR 1.200 per School Year)

Scholarship

Received scholarship

Scholarship Request, in addition to the one already received for the same school year, if any (EUR 100 file costs refunded in case of acceptance)

Is your Application Conditioned to the Receipt of a Scholarship (in addition to the one already received for the same school year, if any)? *

Yes

Other information

French level *

Beginner

Elementary

Intermediate

Advanced or better

Remarks/Additional Info

Please check this box to confirm your engagement for which you declare to be informed of the invoicing schedule of the selected services *

Job

Department

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